Você pesquisou por y - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2010;32(2):100-100
Summary
Rev Bras Ginecol Obstet. 2010;32(2):100-100
Summary
Summary
Summary
Rev Bras Ginecol Obstet. 2010;32(2):61-65
DOI 10.1590/S0100-72032010000200002
PURPOSE: to analyze the occurrence of conjoined twins at a tertiary perinatology reference university hospital over a period of 25 years (January 1982 to January 2007) and to describe the successful separation of one of the pairs. METHODS: we consulted retrospectively the database of the University Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Brazil, in order to determine the number of pairs of conjoined twins, their frequency, classification, gender, type of pregnancy resolution, attempted surgical separation, prenatal diagnosis and survival. RESULTS: we detected 14 pairs of conjoined twins (1/22,284 live births and 1/90 pairs of twin live births) born during this period (six males, seven females and one of indeterminate sex). The prenatal diagnosis was performed in all twins and all births were accomplished by cesarean section. The separation was possible in only one pair, which survives in excellent health conditions after eight years. Of the remaining 13, ten died on the day of birth and three survived only a few months (less than one year). CONCLUSION: Although our study revealed an abnormally high number of conjoined twins, this is a rare phenomenon, with a poor perinatal prognosis depending on the organs shared by the twins and associated malformations, especially those related to the fetal heart. Due to the poor prognosis of these pairs and to the maternal reproductive impairment caused by the need to perform body cesareans, we suggest that, based on these numbers, early interruption of these pregnancies be legally granted, as in the case of other diseases incompatible with fetal survival outside the uterus. Thus, the confirmation of a diagnosis of conjoined twins and the resolution of pregnancy should be performed at a tertiary obstetric and perinatal care center, and an authorization for the interruption of pregnancy should be obtained by judicial means.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):61-65
DOI 10.1590/S0100-72032010000200002
PURPOSE: to analyze the occurrence of conjoined twins at a tertiary perinatology reference university hospital over a period of 25 years (January 1982 to January 2007) and to describe the successful separation of one of the pairs. METHODS: we consulted retrospectively the database of the University Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Brazil, in order to determine the number of pairs of conjoined twins, their frequency, classification, gender, type of pregnancy resolution, attempted surgical separation, prenatal diagnosis and survival. RESULTS: we detected 14 pairs of conjoined twins (1/22,284 live births and 1/90 pairs of twin live births) born during this period (six males, seven females and one of indeterminate sex). The prenatal diagnosis was performed in all twins and all births were accomplished by cesarean section. The separation was possible in only one pair, which survives in excellent health conditions after eight years. Of the remaining 13, ten died on the day of birth and three survived only a few months (less than one year). CONCLUSION: Although our study revealed an abnormally high number of conjoined twins, this is a rare phenomenon, with a poor perinatal prognosis depending on the organs shared by the twins and associated malformations, especially those related to the fetal heart. Due to the poor prognosis of these pairs and to the maternal reproductive impairment caused by the need to perform body cesareans, we suggest that, based on these numbers, early interruption of these pregnancies be legally granted, as in the case of other diseases incompatible with fetal survival outside the uterus. Thus, the confirmation of a diagnosis of conjoined twins and the resolution of pregnancy should be performed at a tertiary obstetric and perinatal care center, and an authorization for the interruption of pregnancy should be obtained by judicial means.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):66-71
DOI 10.1590/S0100-72032010000200003
PURPOSE: to evaluate the importance of maternal plasma concentration of fructosamine as an indicator of fetal congenital cardiopathies in pregnancies complicated by diabetes mellitus. METHODS: this was a retrospective study conducted on 91 pregnant women with diabetes mellitus who underwent routine fetal echocardiography at a university reference center in fetal medicine. Sixty-five patientes who presented pre-gestational diabetes mellitus and plasma fructosamine level were registered in the medical records prior to the ultrasound exam. The first measurement recorded was compared with the result of routine fetal echocardiography, carried out by a specialist physician of the service. The presence or absence of echocardiographic findings of congenital cardiopathies (EFCC) was related to plasma levels of fructosamine by the mean t-test and its accuracy for EFCC was verified by the ROC curve. Plsama fructosamine concentrations of 2.68, 2.9 and 2.23 mmol/L, which are, respectively, the local reference laboratory values, the value of the kit employed for measurement and the one of highest overall accuracy, were discussed as the cut-off values. RESULTS: EFCC was found in 52.3% of the fetuses. The first measurement of fructosamine, during the prenatal care period, was performed, on average, at 20.4±8.0 weeks of pregnancy. The maternal concentration ability of the fructosamine to identify fetuses with EFCC was significant (p<0.0001) and had an area under the ROC curve of 0.78 (95%CI=0.66-0.89). The 2.9 mmol/L plasma concentration of fructosamine revealed EFCC with better specificity, but with a higher percentage of false-negative results (96.8 and 55.9%). Values above 2.68 mmol/L were associated with a probability of 4.6 to identify fetuses with EFCC compared with lower values, with 58.8% of sensitivity and 87.1%, specificity. The value of 2.23 mmol/L proved to be the most overall accurate of the three values suggested, with a sensitivity of 88.2% in the identification of fetuses with echocardiographic abnormalities. CONCLUSIONS: it is possible to use a second trimester plasma fructosamine level to refer high risk pregnant women to a reference center of fetal echocardiography. These findings are important for the management of women with diabetes mellitus who initiate late prenatal care.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):66-71
DOI 10.1590/S0100-72032010000200003
PURPOSE: to evaluate the importance of maternal plasma concentration of fructosamine as an indicator of fetal congenital cardiopathies in pregnancies complicated by diabetes mellitus. METHODS: this was a retrospective study conducted on 91 pregnant women with diabetes mellitus who underwent routine fetal echocardiography at a university reference center in fetal medicine. Sixty-five patientes who presented pre-gestational diabetes mellitus and plasma fructosamine level were registered in the medical records prior to the ultrasound exam. The first measurement recorded was compared with the result of routine fetal echocardiography, carried out by a specialist physician of the service. The presence or absence of echocardiographic findings of congenital cardiopathies (EFCC) was related to plasma levels of fructosamine by the mean t-test and its accuracy for EFCC was verified by the ROC curve. Plsama fructosamine concentrations of 2.68, 2.9 and 2.23 mmol/L, which are, respectively, the local reference laboratory values, the value of the kit employed for measurement and the one of highest overall accuracy, were discussed as the cut-off values. RESULTS: EFCC was found in 52.3% of the fetuses. The first measurement of fructosamine, during the prenatal care period, was performed, on average, at 20.4±8.0 weeks of pregnancy. The maternal concentration ability of the fructosamine to identify fetuses with EFCC was significant (p<0.0001) and had an area under the ROC curve of 0.78 (95%CI=0.66-0.89). The 2.9 mmol/L plasma concentration of fructosamine revealed EFCC with better specificity, but with a higher percentage of false-negative results (96.8 and 55.9%). Values above 2.68 mmol/L were associated with a probability of 4.6 to identify fetuses with EFCC compared with lower values, with 58.8% of sensitivity and 87.1%, specificity. The value of 2.23 mmol/L proved to be the most overall accurate of the three values suggested, with a sensitivity of 88.2% in the identification of fetuses with echocardiographic abnormalities. CONCLUSIONS: it is possible to use a second trimester plasma fructosamine level to refer high risk pregnant women to a reference center of fetal echocardiography. These findings are important for the management of women with diabetes mellitus who initiate late prenatal care.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):72-76
DOI 10.1590/S0100-72032010000200004
PURPOSE: to translate into Brazilian Portuguese and culturally adapt the Short Personal Experiences Questionnaire (SPEQ) to climacteric women. METHODS: the original English version from the University of Melbourne, Australia, was initially translated into Portuguese and back-translated into English. A sociocultural adaptation of vocabulary and linguistic constructions was performed to facilitate comprehension. The questionnaire was then pretested in successive stages in 50 women, until no doubts remained. The final version of the adapted instrument was self-responded by 378 Brazilian-born women, between 40 to 65 years old, with 11 years or more of schooling in a population-based study. The reliability (internal consistency as measured by Cronbach's alpha), the construct validity (correlation coefficients between the items comprising the SPEQ and selected variables) and the criterion validity (correlation coefficient between sexual dysfunction score and overall score of sexual life classification) were analyzed. RESULTS: one hundred and eight women answered all the questions of the SPEQ and were included in the study. Internal consistency (Cronbach's alpha) for all the nine SPEQ items ranged from 0.55 to 0.77 and the general alpha was 0.68. In the construct validity analysis, most of the correlation coefficients were significant (p<0.005). The criterion validity analysis showed significant correlation coefficients in most cases. CONCLUSIONS: following the adaptation process, the Portuguese version of the SPEQ was deemed useful and appropriate for collecting data on sexual function and dyspareunia in Brazilian women, aged 45 to 65 years, with at least 11 years of schooling.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):72-76
DOI 10.1590/S0100-72032010000200004
PURPOSE: to translate into Brazilian Portuguese and culturally adapt the Short Personal Experiences Questionnaire (SPEQ) to climacteric women. METHODS: the original English version from the University of Melbourne, Australia, was initially translated into Portuguese and back-translated into English. A sociocultural adaptation of vocabulary and linguistic constructions was performed to facilitate comprehension. The questionnaire was then pretested in successive stages in 50 women, until no doubts remained. The final version of the adapted instrument was self-responded by 378 Brazilian-born women, between 40 to 65 years old, with 11 years or more of schooling in a population-based study. The reliability (internal consistency as measured by Cronbach's alpha), the construct validity (correlation coefficients between the items comprising the SPEQ and selected variables) and the criterion validity (correlation coefficient between sexual dysfunction score and overall score of sexual life classification) were analyzed. RESULTS: one hundred and eight women answered all the questions of the SPEQ and were included in the study. Internal consistency (Cronbach's alpha) for all the nine SPEQ items ranged from 0.55 to 0.77 and the general alpha was 0.68. In the construct validity analysis, most of the correlation coefficients were significant (p<0.005). The criterion validity analysis showed significant correlation coefficients in most cases. CONCLUSIONS: following the adaptation process, the Portuguese version of the SPEQ was deemed useful and appropriate for collecting data on sexual function and dyspareunia in Brazilian women, aged 45 to 65 years, with at least 11 years of schooling.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):77-81
DOI 10.1590/S0100-72032010000200005
PURPOSE: to determine the dose of ionizing radiation absorbed by the ovaries and the skin of patients undergoing uterine fibroid embolization (UFE), and to suggest a radiologic protocol directed at reducing the risks involved in this procedure. METHODS: seventy-three consecutive women (mean age: 27 years) participating in an institutional research protocol, having symptomatic uterine fibroids with indication for minimally invasive treatment, underwent UFE. We estimated the radiation absorbed by the ovaries by means of vaginal dosimeters and the radiation dose absorbed by the skin by means of indirect calculations of radiation absorption. The first 49 patients belonged to the Pre-modification Group, and the last 24, to the Post-modification Group. The second group received a modified protocol of X-ray imaging, with a reduction by half of the frames number per second during arteriography, in an attempt to match the values obtained to those of the literature, and avoiding as much as possible unnecessary exposure to the X-ray beam. RESULTS: there were no technical complications in any of the procedures performed. There were no differences in the mean fluoroscopy time or in the mean number of arteriographies between the two groups. We obtained a 57% reduction in the estimated absorbed ovarian dose between groups (29.0 versus 12.3 cGy) and a 30% reduction in the estimated dose absorbed by the skin (403.6 versus 283.8 cGy). CONCLUSIONS: a significant reduction in the absorption of radiation in patients undergoing UFE can be achieved by changing the number of frames per second in angiographic series, and by the routine use of radiological protection standards.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):77-81
DOI 10.1590/S0100-72032010000200005
PURPOSE: to determine the dose of ionizing radiation absorbed by the ovaries and the skin of patients undergoing uterine fibroid embolization (UFE), and to suggest a radiologic protocol directed at reducing the risks involved in this procedure. METHODS: seventy-three consecutive women (mean age: 27 years) participating in an institutional research protocol, having symptomatic uterine fibroids with indication for minimally invasive treatment, underwent UFE. We estimated the radiation absorbed by the ovaries by means of vaginal dosimeters and the radiation dose absorbed by the skin by means of indirect calculations of radiation absorption. The first 49 patients belonged to the Pre-modification Group, and the last 24, to the Post-modification Group. The second group received a modified protocol of X-ray imaging, with a reduction by half of the frames number per second during arteriography, in an attempt to match the values obtained to those of the literature, and avoiding as much as possible unnecessary exposure to the X-ray beam. RESULTS: there were no technical complications in any of the procedures performed. There were no differences in the mean fluoroscopy time or in the mean number of arteriographies between the two groups. We obtained a 57% reduction in the estimated absorbed ovarian dose between groups (29.0 versus 12.3 cGy) and a 30% reduction in the estimated dose absorbed by the skin (403.6 versus 283.8 cGy). CONCLUSIONS: a significant reduction in the absorption of radiation in patients undergoing UFE can be achieved by changing the number of frames per second in angiographic series, and by the routine use of radiological protection standards.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):82-87
DOI 10.1590/S0100-72032010000200006
PURPOSE: to study the clinical and microbiological profile of women with bacterial vaginosis participating in a randomized, double-blind clinical trial, which compared the vaginal use of preparations from red pepper tree and metronidazole for the treatment of genital discharge. METHODS: the study was conducted on a series of 277 women with bacterial vaginosis concomitantly diagnosed by the criteria of Amsel and Nugent, selected from a total of 462 recruited patients using the information obtained before intervention. Data were analyzed with the Epi-Info 3.32 software. In order to compare the outcomes frequencies between the intervention groups, the χ2 test was used and the risk ratio and 95% confidence interval were calculated. The intention to treat analysis was performed. In addition to the determination of diagnostic parameters, the culture of vaginal content and a Papanicolaou cytology test were also performed. RESULTS: the most frequent clinical complaints were genital discharge, observed in 206 participants (74.4%) and the fish odor of the vaginal secretion, which occurred in 68.6% of the cases (190 patients). Among the diagnostic clinical criteria, the presence of clue-cells was positive in 275 women (99.3%), the Whiff test, in 266 (96.0%), followed by pH >4.5, which occurred in 92.8% of the cases, and by the presence of fluid grayish discharge reported by 206 participants (74.4%). Regarding the Nugent criterion, the median score was 8.0. Culture of the vaginal content permitted the identification of Gardnerella vaginalis in 96.8% of cases and of Mobiluncus in 53.1%. Only one third of the exams showed the presence of Lactobacillus (89 women - 32.1%). Fungal growth occurred in the cultures of 14 participants (5.1%). In most cases, culture revealed the presence of Corynebacterium (94.2%), Gram-positive cocci (98.2%), as well as Gram-positive (99.3%) and Gram-negative (91.0%) bacilli. Oncotic colposcopy revealed a very scarce presence of lactobacilli, which were present in only 8 cytological exams (2.9%) out of the total of 273 exams performed. CONCLUSIONS: the results of the present study did not differ from the literature regarding the symptoms reported by the women, the clinical criteria most frequently observed in the diagnosis, or the bacterial species detected in cultures of vaginal content. These findings indicate the need for further studies that might better elucidate the interrelations between the microbiological findings and the clinical expression of bacterial vaginosis.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):82-87
DOI 10.1590/S0100-72032010000200006
PURPOSE: to study the clinical and microbiological profile of women with bacterial vaginosis participating in a randomized, double-blind clinical trial, which compared the vaginal use of preparations from red pepper tree and metronidazole for the treatment of genital discharge. METHODS: the study was conducted on a series of 277 women with bacterial vaginosis concomitantly diagnosed by the criteria of Amsel and Nugent, selected from a total of 462 recruited patients using the information obtained before intervention. Data were analyzed with the Epi-Info 3.32 software. In order to compare the outcomes frequencies between the intervention groups, the χ2 test was used and the risk ratio and 95% confidence interval were calculated. The intention to treat analysis was performed. In addition to the determination of diagnostic parameters, the culture of vaginal content and a Papanicolaou cytology test were also performed. RESULTS: the most frequent clinical complaints were genital discharge, observed in 206 participants (74.4%) and the fish odor of the vaginal secretion, which occurred in 68.6% of the cases (190 patients). Among the diagnostic clinical criteria, the presence of clue-cells was positive in 275 women (99.3%), the Whiff test, in 266 (96.0%), followed by pH >4.5, which occurred in 92.8% of the cases, and by the presence of fluid grayish discharge reported by 206 participants (74.4%). Regarding the Nugent criterion, the median score was 8.0. Culture of the vaginal content permitted the identification of Gardnerella vaginalis in 96.8% of cases and of Mobiluncus in 53.1%. Only one third of the exams showed the presence of Lactobacillus (89 women - 32.1%). Fungal growth occurred in the cultures of 14 participants (5.1%). In most cases, culture revealed the presence of Corynebacterium (94.2%), Gram-positive cocci (98.2%), as well as Gram-positive (99.3%) and Gram-negative (91.0%) bacilli. Oncotic colposcopy revealed a very scarce presence of lactobacilli, which were present in only 8 cytological exams (2.9%) out of the total of 273 exams performed. CONCLUSIONS: the results of the present study did not differ from the literature regarding the symptoms reported by the women, the clinical criteria most frequently observed in the diagnosis, or the bacterial species detected in cultures of vaginal content. These findings indicate the need for further studies that might better elucidate the interrelations between the microbiological findings and the clinical expression of bacterial vaginosis.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):88-93
DOI 10.1590/S0100-72032010000200007
PURPOSE: to evaluate the effect of the prolonged use of a high dose of tibolone on the body weight variation and lipid profile of oophorectomized female rats. METHODS: 15 Wistar rats weighing 250 g were randomly divided into two groups. The Experimental Group (n=9) received 1 mg/day of oral tibolone. The Control Group (n=6) received daily 0.5 mL of 0.5% carboxymethylcellulose by gavage. Bilateral oophorectomy was performed 30 days before the beginning of the experiment. On day 0 of the experiment, the animals began to receive the respective treatment for 20 weeks. Body weight was controlled every seven days and food consumption was measured every three to four days along the experiment, in order to establish the daily mean consumption per animal. The results were compared by the Student's t-test, with the significance level set at p<0.05. RESULTS: the daily food consumption of the Tibolone Group was significantly lower (12.7±1.2 g, p<0.001) compared to the Control Group (14.5±1.4 g). This difference was also significant when the body weight was compared between the Tibolone and Control Groups (p<0.001), with the Tibolone Group having lower weight along the experiment. At the end of the experiment, the mean body weight was 215.6±9.3 g in the Tibolone Group and 243.6±6.4 g in the Control Group. Regarding the lipid profile, the Tibolone Group had significantly (p<0.001) lower total cholesterol compared to the Control Group (30.3 versus 78.6 mg/dL). The level of HDL-c was also significantly different (p<0.001), with the Tibolone Group showing lower levels than the Control Group (9.0 versus 52.0 mg/dL). No significant difference between the groups was registered in the other biochemical parameters examined (LDL-c, VLDL-c and triglycerides). CONCLUSIONS: tibolone causes a significant reduction of HDL-c and total cholesterol and has a deleterious effect on the body weight of oophorectomized rats, which may be related to the lower food ingestion by these animals.
Summary
Rev Bras Ginecol Obstet. 2010;32(2):88-93
DOI 10.1590/S0100-72032010000200007
PURPOSE: to evaluate the effect of the prolonged use of a high dose of tibolone on the body weight variation and lipid profile of oophorectomized female rats. METHODS: 15 Wistar rats weighing 250 g were randomly divided into two groups. The Experimental Group (n=9) received 1 mg/day of oral tibolone. The Control Group (n=6) received daily 0.5 mL of 0.5% carboxymethylcellulose by gavage. Bilateral oophorectomy was performed 30 days before the beginning of the experiment. On day 0 of the experiment, the animals began to receive the respective treatment for 20 weeks. Body weight was controlled every seven days and food consumption was measured every three to four days along the experiment, in order to establish the daily mean consumption per animal. The results were compared by the Student's t-test, with the significance level set at p<0.05. RESULTS: the daily food consumption of the Tibolone Group was significantly lower (12.7±1.2 g, p<0.001) compared to the Control Group (14.5±1.4 g). This difference was also significant when the body weight was compared between the Tibolone and Control Groups (p<0.001), with the Tibolone Group having lower weight along the experiment. At the end of the experiment, the mean body weight was 215.6±9.3 g in the Tibolone Group and 243.6±6.4 g in the Control Group. Regarding the lipid profile, the Tibolone Group had significantly (p<0.001) lower total cholesterol compared to the Control Group (30.3 versus 78.6 mg/dL). The level of HDL-c was also significantly different (p<0.001), with the Tibolone Group showing lower levels than the Control Group (9.0 versus 52.0 mg/dL). No significant difference between the groups was registered in the other biochemical parameters examined (LDL-c, VLDL-c and triglycerides). CONCLUSIONS: tibolone causes a significant reduction of HDL-c and total cholesterol and has a deleterious effect on the body weight of oophorectomized rats, which may be related to the lower food ingestion by these animals.
